This Week in Managed Care: January 2, 2016

Hello, I’m Justin Gallagher, associate publisher of The American Journal of Managed Care.

Welcome to This Week in Managed Care, from the Managed Markets News Network.

Hepatitis C Costs Too High

What happens when there’s a cure for your disease, but it just costs too much? If you have hepatitis C and are covered by Medicaid, that’s a combination that may put a solution out of reach.

Medicaid officials in 34 states won’t pay for expensive medications like Sovaldi or Harvoni because the costs are just too high, except for patients who also have complications like HIV or a liver transplant. But those with hepatitis C say that’s unfair, and public health officials argue it’s inviting the spread of the disease.

In states like Indiana, some patients are joining forces to sue, led by groups like the ACLU. Those who represent Medicaid say even if the price of hepatitis C drugs were cut in half, it would still be too much for states to pay.

Said Matt Salo of the National Association of Medicaid Directors: “It is just not feasible to provide it to everyone. Sates have to make sure that we’re going to prioritize and that those who need it the most get priority treatment.”

Opioid Overdose

A study published this week in the Annals of Internal Medicine found that 91% of patients who survived an opioid overdose were able to get another prescription for the drug, often from the same doctor. This surprising discovery comes as the nation looks for answers to soaring rates of addiction to prescription painkillers and heroin.

An editorial that appeared with the study called for better communication and training for doctors, who often are not told about a patient’s overdose, and are not taught to look for signals that one has occurred.

Cancer Center Halts Trial

Martin Shkreli’s arrest for securities fraud continues to have ripple effects across the pharmaceutical world. While Shkreli was best-known for his role at Turing Pharmaceuticals and hiking the price of Daraprim, he also had become the head of KaloBios Pharmaceuticals, which is developing a therapy for chronic myelomoncytic leukemia.

Now, even though Shkreli has been kicked out of KaloBios, one of the premier cancer research and treatment centers has halted a clinical trial with the therapy because of the connection to Shkreli. Moffitt Cancer Center announced it will suspend the trial until more is known about the securities investigation, even though there’s no problem with the leukemia therapy itself.

Moffitt spokesman Stephen Blanchard told the Tampa Bay Times that the trial was “on hold” pending the outcome of the investigation, which concerns how Shkreli repaid investors from a hedge fund.

Now, KaloBios has filed for bankruptcy.

No Injunction in OMNIA Case

There was no Christmas Eve miracle for a hospital in New Jersey that hoped a judge would compel Horizon Blue Cross and Blue Shield to include it in the preferred tier of its OMNIA plan, which has taken effect with the new year.

St. Peter’s of New Brunswick has brought one of three suits against Horizon over the OMNIA plan, which has attracted national attention for a controversial effort to bring population health to the state. While some will experience lower rates, many urban and independent hospitals have challenged the plan in court, saying they were unfairly excluded from the preferred tier.

Best of 2015

We’ve bid farewell to 2015, but you can see the top choices for research articles, news, and videos from our readers by visiting AJMC.com. We look forward to bringing you more managed care updates in 2016.

For all of us here at the Managed Markets News Network, Happy New Year!

I’m Justin Gallagher. Thanks for joining us.